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senate vote 2022-10-27#4
Edited by
mackay staff
on
2022-11-03 14:16:34
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Title
Bills — Aged Care Amendment (Implementing Care Reform) Bill 2022; in Committee- Aged Care Amendment (Implementing Care Reform) Bill 2022 - in Committee - Reasonable steps and some definitions
Description
<p class="speaker">Anne Ruston</p><p>I'd like to ask the minister a few questions before I move my amendment. Minister, could I get some clarification in relation to the budgeting around this particular measure? I note in the explanatory memorandum that there is an amount of funding, and I've asked the department, through questions, to explain to me how exactly the funding attached to the bill is going to be spent, but I haven't had a response yet. This is somewhat frustrating, given that the government are seeking for us to pass this bill despite the lack of information that has been provided in relation to the delegated legislation, which is so important to be able to understand exactly what is going to be required. Minister, can you give me some idea of what the funding allocated in your explanatory memorandum will be going to?</p>-
- The majority voted against [amendments](https://www.openaustralia.org.au/senate/?gid=2022-10-27.79.1) introduced by South Australian Senator [Anne Ruston](https://theyvoteforyou.org.au/people/senate/sa/anne_ruston) (Liberal), which means they failed.
- ### Amendment text
- > *(1) Schedule 1, item 2, page 4 (after line 5), at the end of paragraph 54-1A(4)(a), add:*
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- >> *(iii) in considering whether the provider has taken reasonable steps, the Secretary must consider whether the provider will undertake reasonable measures to provide the highest level of clinical care with the available workforce, which may include measures for the support of clinical care by enrolled nurses and through telehealth consultations with registered nurses (within the meaning of the Health Insurance Act 1973); and*
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- > *(2) Schedule 1, item 2, page 4 (after line 23), at the end of section 54-1A, add:*
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- >> *(6) In this section:*
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- >> *en rolled nurse means a person who is registered under the National Law (within the meaning of the Health Insurance Act 1973) in the nursing profession as an enrolled nurse.*
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- >> *telehealth consultation means a consultation conducted (other than in person) by videoconference, telephone or other technology.*
<p class="speaker">Murray Watt</p><p>The information I've been provided with is that—in accordance with the financial impact statement and the explanatory memorandum to the bill—the indicative financial impacts over the forward estimates of each of these measures are: for schedule 1, which involves the extra nurses who will be needed, $450.7 million; for schedule 2, which relates to capping home care fees, $1.2 million; and schedule 3, which relates to transparency and reporting, $8.1 million.</p> <p class="speaker">Anne Ruston</p><p>In calculating the $450.7 million that's been allocated for schedule 1—relating to the requirement for 24/7 nurses—what provision has been made for the likelihood of exemptions?</p> <p class="speaker">Murray Watt</p><p>I'll just try and get some advice on that point. While I'm obtaining that advice, I'll just reiterate this point: it is disappointing to see the opposition continue to do what they did for 10 years—which is failing to deal with the need for 24/7 nurses in Australian aged-care facilities. As I said earlier, when I was talking about this issue in the run-up to the election, I found people were shocked that we don't have 24/7 registered nurses in aged-care facilities. It's very clear that one of the reasons for the range of appalling incidents that we've seen involving care in aged care is not bad staff but a lack of staff. It seems that the opposition continues to want to delay this important measure, which is about providing extra support for residential aged-care workers so that they can provide better care for residents. I've already acknowledged that there are challenges in implementing this in rural and regional environments, and that's why this government is putting more resources into fixing this situation than we ever saw from the former government. As I say, it's disappointing to see these ongoing delay tactics from the opposition when we finally have a government that wants to fix it.</p><p>The information that I have been provided with just now is that the government will be providing, overall over four years, $2.5 billion towards 24/7 and increased care minutes. We're introducing a 24/7 registered nurse supplement to support residential aged-cares services to employ extra registered nurses to be on site and on duty 24 hours a day, seven days a week. We'll invest $473.3 million over three years from 1 July 2023 in a new RN supplement that tops up Australian National Aged Care Classification care minutes funding to support smaller services to meet their 24/7 requirement. Initially, the supplement will be available to eligible services providing care to up to 60 residents. Services over this size will not receive the supplement, as their existing care minutes funding will be sufficient for providing 24-hour care, taking into account the previously announced funding increases and the additional $1.9 billion in Australian National Aged Care Classification funding in the budget to increase care minutes to 215 minutes, including 44 RN minutes, from 1 October 2024. This supplement will be available to eligible providers from 1 July 2023.</p><p>On exemptions, the government has considered feedback from the sector around current workforce shortages and will allow one-off 12-month exemptions to the 24/7 RN requirement for all services of 30 or fewer beds in modified Monash model 5 to 7 areas. This exemption is provided on the basis that small rural and remote services are likely to face the most significant workforce challenges in recruiting sufficient RNs to meet the requirement. Exempt services will not, of course, receive the RN supplement. We are taking into account the challenges that rural and remote services in particular will have in attracting workforce. Again, if we'd had a government at some point over the last 10 years that had been prepared to invest in workforce and prepared to build the skills of the workforce, then perhaps we wouldn't be having this problem.</p> <p class="speaker">Anne Ruston</p><p>I have a number of questions, and I absolutely don't want to delay the passage of this legislation, despite the false information you have just put on the record. In quite short answers, could you please advise: is the $450.7 million that has been allocated to schedule 1 one-off funding or an ongoing measure?</p> <p class="speaker">Murray Watt</p><p>It's an ongoing measure over the forward estimates.</p> <p class="speaker">Anne Ruston</p><p>I'm seeking clarification on your answer. The $450.7 million is for four years. Are you saying that this will be continued funding past the end of the forward estimates or a one-off allocation for the four years of this budget cycle?</p> <p class="speaker">Murray Watt</p><p>Senator Ruston, as you well know, having been in government, the way governments structure their budgets is to provide funding for four years. Any decisions about future funding beyond the forward estimates are obviously made closer to the end of the forward estimates, but I can't see any situation in which we would walk away from this.</p> <p class="speaker">Anne Ruston</p><p>Will this funding go to providers who currently do not have an RN on-site, or will it be allocated more generally?</p> <p class="speaker">Murray Watt</p><p>The advice to me is that the money will be allocated on the basis of the modified Monash model level that I referred to earlier, but the funding will be provided both to services that have an RN now and services that don't have an RN, provided they meet that modified Monash model test.</p> <p class="speaker">Anne Ruston</p><p>Can I take it from that that modified Monash 1, as an example, will not have access to the $450.7 million, whereas more remote and inaccessible operators will get access to it? That is, it is entirely based on the modified Monash model and not on need.</p> <p class="speaker">Murray Watt</p><p>I'm taking advice as we're debating this, but to be clear, there are two issues. There is the one-off 12-month exemption that's provided, which applies to services of 30 or fewer beds in modified Monash model 5 to 7 areas. As to whether services in modified Monash model 1 areas, for instance, get extra funding, the answer is that if they have 60 beds or less then they would be eligible for that funding. So, it's possible that I misled you before. My answer earlier in reference to the level 5 to 7 areas was in relation to the exemption rather than the funding. I apologise for any confusion.</p> <p class="speaker">Anne Ruston</p><p>I'm keen to understand: in the determination of the expenditure of the $450.7 million for schedule 1, you've said that it's available to any provider with 60 beds or less. Could you advise on whether there is any mechanism within the determination that would differentiate between a provider who was struggling with the current workforce crisis or rewarding bad providers? We know that, sadly, we do have some of those out there. So, is there a mechanism that will actually determine the most imperative issue that is before us at the moment, which is workforce crisis versus rewarding bad providers?</p> <p class="speaker">Murray Watt</p><p>While I get some advice on that specific point, I might just give you a bit more information about how this supplement will work and who it will be paid to. The 24/7 RN supplement will be introduced from 1 July 2023 to support residential aged-care services to employ extra RNs to be onsite and on duty 24 hours a day, seven days a week. This supplement is targeted at small services—up to 60 residents—in recognition of the extra support these services need in order to deliver 24/7 RN coverage. The RN supplement provides up to $733,000 in funding per annum to rural and remote services in Modified Monash Model areas 5 to 7 and is paid at a higher rate to rural and remote services, recognising the increased costs in attracting nurses to work in rural and remote areas. The supplement is expected to be available to around 90 per cent of—I've never quite known whether you say 'triple M' or 'MMM'—areas 5 to 7 services, compared with under 40 per cent of more-metropolitan services in MMM areas 1 to 4. So, it will be eligible for both rural and urban, and it's more dependent on the size of the service.</p> <p class="speaker">Anne Ruston</p><p>Can I take it from that that the $733 million that you just referred to in the supplement is not actually contained in the explanatory memorandum as a cost associated with the bill—that you've only got $450.7 million, which relates to the support for the nursing homes to employ extra RNs? I'm just seeking clarification on what you actually just said. You said that the $450.7 million was to support facilities to employ extra RNs. So, what you've just said somewhat contradicts what you said before. You said it would be available to all facilities as long as they met the 60-or-below threshold, but what you've just said is that it is for them to employ extra RNs. Is the $450.7 million able to be used to provide extra RNs, even at facilities that already have 24/7 RNs?</p> <p class="speaker">Murray Watt</p><p>The advice I've received is that that supplement would be available to services that do already have 24/7 RNs in place, provided that they have 60 or fewer beds. That's in recognition that those smaller services, whether large, small, rural or urban, have additional difficulties.</p> <p class="speaker">Anne Ruston</p><p>Can I just quickly seek some clarification: we've got $450.7 million for schedule 1 of this bill, and you've just told me $733 million for the supplement. So, where is the $733 million currently allocated for in the budget? Where is the $450.7 million allocated in the budget? And what is the differentiation, in terms of what you're taking to me about, between the $450.7 million and the $733 million? Which is the supplement? Or are they both the same thing?</p> <p class="speaker">Murray Watt</p><p>I'd been wondering where you got that $733 million figure from. What I said, unless I said the wrong thing—I was talking about $733,000 in funding per annum to rural and regional and remote services, not $733 million. That is per service. Just to repeat the point: the RN supplement provides up to $733,000 in funding per annum to rural and remote services in MMM areas 5 to 7, and it's paid at a higher rate to rural and remote services because of the increased costs that they will incur.</p> <p class="speaker">Anne Ruston</p><p>Moving on to the exemptions that exist under this particular schedule: can you please advise where you're up to regarding your current considerations about what would constitute an exemption under this legislation?</p> <p class="speaker">Murray Watt</p><p>This legislation puts in place a process to then create exemptions. Early consultation has begun. I'm advised an exposure draft of the exemptions will be finalised soon—it's currently being drafted—and there will be a consultation process on that exposure draft.</p> <p class="speaker">Anne Ruston</p><p>RUSTON (—) (): Do you think there's any possibility we could get a little more detail about when that exposure draft is likely to be available?</p> <p class="speaker">Murray Watt</p><p>Early next year.</p> <p class="speaker">Anne Ruston</p><p>Clearly, you're not going to provide us any more advice around the process of what is in your mind in relation to general attempts to try and obtain a RN. Or can you provide us with more information on that?</p> <p class="speaker">Murray Watt</p><p>We're working out the specifics at the moment but the intention is to make it an open and fair process that treats particular facilities on a case-by-case basis. I'm sure Minister Wells will be more than happy to provide a briefing to you once the consultation process begins.</p> <p class="speaker">Anne Ruston</p><p>In relation to that, what communication, consultation and certainty have you given providers to date regarding how the exemption process will work? Or are you just going to leave them to wait until they see the exposure draft, or have you been talking to them? If you put out an exposure draft, we're not going to see the delegated legislation until April next year—that's what I was advised when I asked about this in committee. Where does that leave providers who will be frantically trying to seek an exemption and provide the necessary detail to you? I'd like to understand what communication and consultation have you provided to date to give certainty and security to these very important workers in our community.</p> <p class="speaker">Murray Watt</p><p>I'm advised there has been extensive consultation around these commitments already. I won't go through it in great detail, but there was general consultation conducted in relation to the government's election commitments around aged care that occurred with a range of groups, employers, union providers and carers through July and August. General consultation was conducted in relation to legislative amendments with a range of stakeholders from various perspectives through July and August. Specific consultation in relation to exemptions to the 24/7 RN requirement was conducted on 22 July with the funding reform working group. I could run through the members of that group; it essentially includes a wide range of providers and various interest groups. Again, there will be further consultation once we've drafted.</p> <p class="speaker">Anne Ruston</p><p>Can you put on the record how many regional providers the minister has visited, and how many rural, regional and remote providers the minister has discussed the exemption clauses with directly?</p> <p class='motion-notice motion-notice-truncated'>Long debate text truncated.</p>-
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